By Karl Vick
November 6, 2014

The workshop on the 14th floor of the VA’s New York Harbor Healthcare building is a cross between a Civil War charnel house and the R&D lair James Bond visits en route to his latest mission. Arms and legs are scattered on tabletops. So are waterproof microchips, remote controls and camouflage. The role of Q falls to a bearded orthotist-prosthetist named Christopher Fantini, who on the last Friday in October picks up a polished aluminum arm–all the limbs lying about are artificial ones–and performs a bit of magic from some ingenious future: the wrist swivels, fingers flex, the elbow bends, all at the command of a blinking red tassel he wiggles on his shoe.

“This is funded by DARPA,” Fantini says, referring to the Pentagon’s legendary Defense Advanced Research Projects Agency, which invented, among other things, the Internet. No one will argue that the care offered American veterans has been flawless, least of all after the recent scandal at VA hospitals and Walter Reed before that. But when it comes to purpose-driven gadgetry, the prospects for the combat-wounded have advanced in the most dazzling of ways.

That is one message of the James Nachtwey photographs on the pages that follow: applied technology, coupled with grit, can generate something surpassing, a chronicle of striving and redemption that flows straight into the brimming heart of the American story.

But Nachtwey prefers to work in black and white for a reason, and the shadows lurking behind his subjects can be dark indeed. “They had physical injuries, but the injuries we are so ill equipped to help them with are things we can’t see,” says Peter Chiarelli, a retired Army general who led the military’s efforts to temper the most persistent cost of conflict, the brutal loop that traps a combat vet in his own mind. “I think we need to help them with everything, the things we can see and the things we can’t see.”

Years ago I spent a night in the busiest combat hospital in Iraq, talking to Army surgeons struggling with both the workload and a despair that at times hung in their offices like a brown fog. The advances in place all around them had been extraordinary–and, to the surgeons, double-edged. Body armor was saving lives but also shifting injury patterns to the extremities, face and brain. Advances in battlefield medicine brought soldiers and Marines into an operating room less than an hour after sustaining wounds so grievous, they would have been fatal in any previous war. In Vietnam, where more than 58,000 Americans died, there were just about three wounded for every fatality. In Iraq, the ratio climbed to 7 to 1. Each additional survivor was one more person returning with memories that would leave him changed. And a dispiriting number were missing pieces of their bodies, even of their brains. “We can save you,” one of the Baghdad surgeons said with a sigh. “You might not be what you were.”

But then no one is, after war.

The fighting ends, of course. The U.S. war in Afghanistan, at 13 years the longest in the nation’s history, draws to an official close with the calendar year. Yet every conflict persists in the men and women who fought it. World War I was still alive until Frank Buckles passed away in February 2011 at age 110. Vietnam lingers in the aging men who populate VA wards. And the campaigns in Iraq and Afghanistan will grind on for decades, continually muddying the transition from uniformed service to civilian life.

Not that it’s anything but a lurching transition–from war to peace–in the best of times. Back in the States, the simplifying imperatives of unit life are gone. So is the intensity, both of combat and of the relationships combat forges. If, as David Finkel wrote in Thank You for Your Service, war is about loving the guy standing next to you, all at once that guy is a fellow pedestrian, waiting for the light.

“There’s this profound sense of alienation that you feel when you come home from war,” says Phillip Carter, who served in Iraq from 2005 to 2006 and is now a senior fellow at the Center for a New American Security. “This society’s so different from what you’ve lived in for the last 14 months–exacerbated by the fact that so few people in America have a visceral connection to the military.”

To this alienation add, if you will, the subtraction of a limb. Or, more common, a recurring nightmare, custom-made to amplify a precisely remembered horror. In Iraq, former Army Sergeant Steve Moore once saw the bodies of two children hanged over a road for selling sodas to Americans. Home in California, he could not stop seeing them in the faces of his two sons, and he dreamed of people dropping from the sky by their necks.

“What took the longest for me was to heal internally,” says Chris Melendez, 27, a New Yorker. He lost a leg to an IED on a night patrol and, even so, eventually realized his childhood dream of becoming a professional wrestler (for TNA on the cable channel Spike). But first he had to deal with posttraumatic stress that robbed him of sleep and had him jumping out of bed at the sound of a garbage truck. “I have a habit of internalizing.” As luck would have it, his father had served in Vietnam and was right there to listen to the thoughts that keep many vets cooped up in the house, alone.

The Nov. 2 New York City Marathon doubled as an amputee showcase. Alfredo De Los Santos, who lost one leg to an RPG, was the fastest of all across the finish line, winning in the handcycle division. He credits his win to a regimen that has him on a training bike whenever his PTSD won’t let him sleep. “I don’t do it because I want to be the best of the best,” he says. “I do it because I need to do this, not to go crazy.” Cedric King, who lost both legs to an IED, was one of the last to finish, running the entire course on prostheses that broke down twice, at mile 3 and mile 8. He fixed one with an Allen wrench and a disposable lighter and walked the last blocks with a cancer survivor. “That moment right there let me know, You know what? I don’t have it so bad,” King says. “I could have died too. But she’s beat cancer twice and still goes out and talks to people about it. I got a lot of strength from her.” The best part of the marathon? That it was so difficult. “Yesterday let me know that mentally I could be strong enough to endure anything,” he says. “I needed that.”

Few things are as fragile as mental health, and while it’s a truism that technology always advances faster than human behavior, that lag seems crueler when the suffering was incurred in the service of the nation and endured in private. And it becomes inexcusable when a scientific establishment fails to apply itself to relieving the pain. Artificial limbs went from vaguely creepy to the sleek carbon composite of a blade runner in a couple of decades. Mental-health diagnostics went from “operational exhaustion” to PTSD: a name change. Perhaps a third of returning fighters struggle with it in some form, the same proportion as in World War II, Chiarelli observes–and stigma persists. “We have state-of-the-art prosthetics, but when it comes to treating them for traumatic brain injury or posttraumatic stress, they have to go back to the ’30s,” he says. “That’s where we are.”

Is there a way out? Chiarelli, now working for reform as the head of One Mind for Research, laments the lack of investment in the “big science” that could produce practical solutions. Meanwhile, on the ground, narrow pathways are beginning to emerge. Moore found consolation in a service dog offered in a program for vets, a golden retriever that forced him out into the world. Other combat veterans move forward working with horses, or hunting, or sailing, or helping other vets. “Most of these connect at a very primal level,” says Carter. “There’s something very primitive in our connection with animals, in our connection to the outdoors.”

Tech has its role. Virtual-reality software puts the vet back in Iraq or Afghanistan, reliving the trauma so often, it bleeds away some of its paralyzing power. And the hardware of “adaptive sports”–Fantini once made a vet an arm that was a golf club–turns out to be useful in healing the mind as well as the body. It makes sense: besides promoting self-sufficiency and, especially in those who become trainers themselves, a sense of mission, the sports put vets in the company of other vets, the only people who know what they’ve been through. Which is more than anyone should have to bear alone.

–WITH REPORTING BY OLIVIA B. WAXMAN/BETHESDA, MD.

IN THEIR OWN WORDS

THE BEST OF # TIMEVETS

When TIME set out to explore the profound effects of America’s recent wars–both on those who serve and on the people who support them–we knew we couldn’t do it with a single magazine feature or photo essay. So we decided to broaden the conversation. For weeks, we’ve tapped our Facebook, Twitter and Instagram feeds to ask millions of veterans and their families to share photos and stories about readjusting to life after war–stories that are happy, heavy, poignant, inspiring and everything in between. Here, we’re sharing four with you. See more at time.com/vets, and submit your own via email (vets@time.com) or on social media (by tagging a post with #TIMEvets).

ADAM MAGERS, 29

FORMER ARMY SERGEANT

This photo was taken at Camp Liberty in Baghdad in 2008, when my friend Jay (left) and I were getting ready to go on a mission. We were IED hunters, which meant we got very close to getting blown up all the time.

When I got home, I started having panic attacks. I was so paranoid–looking for bombs underneath cushions, pillows, in my closet, my dishwasher, behind my shower curtain. I’d never felt so helpless. I started thinking about suicide.

Right around then, I met a veteran with PTSD who told me about Save a Warrior, a group that teaches meditation. I was skeptical at first, but this guy had attempted suicide, so he knew what it was like to suffer the way I’d been suffering. With the group, I learned how to sit and tell myself not to have anxious thoughts, that they don’t have power over me. I started doing this for 20 minutes every day. And I haven’t had a panic attack since.

JAMES FITZGERALD, 28

FORMER ARMY STAFF SERGEANT

This photo was taken when I was on combat patrol in Afghanistan’s Pech River Valley around July 2010. On Veterans Day of that year, we embarked on an operation called Bulldog Bite. Two days later, we were ambushed. A gunshot wound to my left thigh knocked me off a mountain into a ravine. I fractured my right knee, broke my right femur. But when one of my soldiers got killed the next day–that’s what hurt the most, because I was responsible for those men.

I got sent to an Army medical center in Georgia for three weeks, and I remember having mismanaged pain meds and inattentive doctors. I felt demeaned. I didn’t make a formal complaint, but I told the local ombudsman that something had to change.

About a year later, I was up and moving again and feeling a lot better. I even came out to my soldiers after I was medically retired. Today, I’m still in some pain. But I’ve got things to help me get by: my boyfriend, my lost soldier’s parents and focusing on college. I’d love to have a career in law and run for office one day.

ANNE SPILLANE, 33

ARMY PHYSICIAN

My dad took this photo at my home in Columbia, Md., the day I left for my first deployment to Afghanistan. It was right before July 4, 2013. That day stood out because three years before, I had premature quadruplets. They came at 24 weeks and needed feeding tubes, home oxygen, repeat hospitalizations, surgeries and more to survive. One of them, my son Wyatt, had cerebral palsy. I was doing my residency, and I took a yearlong leave of absence to focus on my family.

Those experiences were incredibly difficult. But they were also important, because they helped me relate to the medical circumstances of families in Afghanistan. I was able to assist other moms in similar situations who didn’t have access to quality medical care.

When I deployed, my children were learning to walk, to run, to eat by mouth. When I came home, they were putting sentences together and running to hug me. They continue to have medical issues, but nobody is on home oxygen anymore. We’re tremendously blessed.

ANTHONY DROZ, 26

FORMER MARINE CORPORAL

My friend took this photo on Aug. 29. I was in Bethlehem, Pa., and I had just finished training for the Spartan Race and an overnight 50-mile hike I did to raise awareness about veteran suicides. I’m third-generation military, and my dad, an Army vet, took his life when I was 12.

Between that and three guys I personally served with in Iraq and Afghanistan getting killed in action, I get hit with a lot of survivor’s guilt. It used to be really rough. I’d go to bed with a bottle of Jameson and wake up drinking a beer. I once got into a motorcycle crash hungover.

Then, a few months later, a friend from my 2009 Iraq deployment signed us up for a kayaking trip with veterans like me. That helped me realize how much I missed having a brotherhood. When I got home, I stayed sober. I started training for a Spartan Race, and the obstacle-race community became my brotherhood. Now I run Flatline Fighters, an online community where vets can share their stories, so people know there are reasons not to give up.

Contact us at editors@time.com.

This appears in the November 17, 2014 issue of TIME.

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